Book Reviews

became possible in this tradition. A belief, say, in the slum's deleterious effects on health (and thus its immorality) was compatible at times with a thesis of racial degeneration: the environment as if grafted into the body (transferred from one ecology to another) and then reproduced across future generations in a spiral of decline. Regeneration and rejuvenation were simply the other side of this coin. A chapter on the campaign for national revival and sport shows a movement obsessed with formidable drift to degeneration, to some nadir of unfitness. Calls for social welfare, physical training, and drastic "surgery" against those elements beyond the pale of the social order could be made simultaneously. Old republican hostilities to the non-productive classes were renewed in clinical terms. As Rene Waldeck-Rousseau, Minister of the Interior put it, incorrigibility faded into incurability: " [We need] a new punishment for the effective and energetic repression of these incurables of vice, these incorrigibles of misdemeanour and crime, who wilfully live outside the boundaries of society, struggle openly against it, and through their repeated infractions, pose a serious and continuous threat to public tranquility." No doubt many of these images have a certain pertinence today, with the resurgence perhaps (in these very different social and political circumstances) of the rhetoric of degeneration-parasitism, competition, fitness ... the host of enemies without and within? In that sense, the fictions of the turn of the last century, from The war of the worlds to Germinal still have their echoes, real or imagined, for the turn of ours. Nye's essays necessarily raise many more themes than they fully engage. But there are some strange under-emphases. The novel, for instance, though clearly important to the subject (to the consolidation of new narratives, a whole historiography, conflating the organic and the social, linking the crises of body and polity in one imaginative frame) is given little attention. Moreover, when Zola or Huysmans is mentioned, it is only to illustrate a discourse assumed to have been forged elsewhere. To a peculiar degree, in fact, degenerationism in the late nineteenth century was produced in a continual refraction between scientific and literary languages. A whole story of decline, civilisation and its discontents, the fall of empires, is therefore at issue in Nye's book but sometimes beyond the terms of the discussion. What is valuably evoked, however, is the conceptual unity of social pathologies in the debates before …

MEDICAL AND PHYSICAL LITERATURE, [foreign and domestic.] TranfaSlions of a Society for the Improvement of Medical and Chirurgical Knowledge, llluftrated with copper-plates. Vol. II. 8vo. pp. 380. London, johnfon. 1800. The defign of this work is fimilar to that of Duncan's Annals of Medicine, or Dr. Simmons's Medical Fa?ts. It appears to be the intention of the editors to admit original papers only; and while they are fupplied by fuch names as ornament the. prefent volume, there can be no doubt that the work will maintain its popularity. This volume contains twenty-nine papers on fome of the mofl interefting fubjefts of medicine and furgery, from which we feleft the following extracts. Account of a Cafe in which Death <vjas brought on by a Haemorrhage from the Liver. By G. Blane, M. D. F. R. S. &c. Read May 6, 1794. " A boy, aged eight years, of a delicate conftitution, fmall ftature, and pale complexion, whofe family on the father's fide had been extremely fubjedt to phthifis pulmonalis, but he himfelf having no fymptoms of fcrofula or rickets, or any external blemiih or deformity, except that his belly had always been too large, and he had been fubjeft to complaints of the ftomach and bowels through life, began to complain on the 12th of March, 1794, of languor, lofs of appetite, and flight pains, which he referred to his breaft and ftomach. Thefe fymptoms continued the fame next day,, but became more fevere on^the 14th, and remained fo the three following days, on the laft of which he became feverifh, and there was an eruption of red fpots on the neck and breaft, which lafled only a few hours. On the iSth and 19th, the fymptoms were milder, and he was thought to be recovering; but in the night between the 19th and 20th, he was fuzed with a fevere pain, which he referred to the left hypochondrium. This continued between five and fix K 2 hours, 68 Dr. Blaney on Hamorrhagc from the Liver. hours, and he then became fuddenly faint, and lofing all fenfe and motion was thought to be in a fwoon, but from this he never recovered. " This is the account which I received from the family and the medical gentleman who attended, for I did not fee him during his illnefs; and not having been fent for till he was in extremities, he had died before I arrived.
" Leave was. obtained to examine the body, and the following Appearances were obferved. Upon laying open the abdomen, a large quantity of coagulated blood was difcovered, covering the whole left fide of the inteftines. In exploring the fource of this, feveral fiflures were obferved in the left lobe of the liver, which were about two-thirds of an inch in length, whence the blood had undoubtedly flowed, for they were found to lead to a cavity in the fubftance of the lobe of about the fize of a pigeon's egg, and full of blood. The peritoneum, on the furface of that part of the liver which was near one of the fiflures, was raifed from the liver like a blifter, full of coagulated blood. Thefe appearances were on the lower furface of the lobe, but on the upper furface of the fame lobe there was one fiflure, round which was a fimilar colle&ion of blood between the peritonaeum and the fubftance of the liver, and it led to a fmall bloody cavity near the furface of the liver. " There was no external livor, or other mark of injury either on the adjacent parietes, or on the fpleen or inteftines. " It feem$ moll probable therefore, that the rupture and confequent haemorrhage were owing to the weak ftrutture of the liver, which correfponded with the general weaknefs of this young perfon's frame. '' It would appear that it is this weaknefsy proceeding from a too great tenuity of the coats of the veflels, that chiefly conftitutes the fcrofulous habit, of which the principal fymptoms feem referrible to a rupture of the fmaller feries of velTels either circulatory or lymphatic, and the confequent effufion either of red blood or colourlefs fluids, occafioning fometimes hemorrhages, but more frequently interftitial or glandular depofits. The fine Ikin and filky hair obfervable in fuch habits are farther in-proof of this. " As far as my reading goes, I have not met with any morbid a? feftion of the liver fimilar to that above defcribed, or have I ever feen or heard of fuch a cafe, which has made me think that it might deferve a place in fome regifter of fadts. It has indeed been alleged, that there is not much utility in recording extraordinary and anomalous cafes, as they are feldom the obje&s of pra&ice. But if there is any juftice in this remark, it applies rather to unufual combinations of fymptoms, than to morbid appearances detetted by diflje&ion; for as the number of bodies that are infpe&ed is comparatively fmall, there is reafon to prefume, that, in the numberlefs others which are not examined, there may be many among, them fimilarly affefted." J' ' The Mr, Rumfey, on Croup.?Dr. Rujfel, cm the Small Pox, dsV. 69 The third paper contains an elaborate Account of the Croup, as it appeared in the Town and Neighbourhood of Chejkam, in Buckinghamjhire, in the Tears 1793 and 1794. By Henry Rumsey, Surgeon at Cheftiam. In this account the author fees reafon for admitting the exiftence of fpafnodic croup as well as inflammatory; and he fays, " It appears to me that the croup is an inflammation of its own kind. If it confifted in common inflammation, we might exped to find the fame appearances (that is, the fame kind of concretion on the furface of the trachea) every day, as its mucous membrane is fo frequently the fubjecl of inflammation attended with an increafed fecretion.
The matter, however, of which this fubftance is formed, poffefles different properties from thofe of the mucous which is thrown out upon the membrane of the nofe, or of the trachea in common catarrhal affedtions.
" I think it probable, that the film which we find in the croup is"not formed by a fecretion from the mucous glands, but is an exfudation from the exhalant arteries. Upon this principle we can more eafily account for fuch film not being found in common catarrhal affe&ions, in which the mucous glands are perhaps more the feat of the difeafe. It is, therefore, analogous to the inflammatory exfudation in the inflammation of other internal membranes firft defcribed by the late Dr. Hunter. " The croup has been fometimes thought infeftious, but I have not been able to form a decided opinion upon this point. Some circumftances render it probable, as two and fometimes three children in the fame family have been feized with it. But on the other hand, I have at different times feen two or three in a family efcape, while one or two of the others have died of it. without any pains being taken to keep thofe who were in health from the ficlc. When a difeafe is epidemic, it is fometimes difficult to determine whether it be communicated by infe&ion, or whether feveral people have the difeafe in confequence cf their being expofed to the fame exciting caufe. It is rather remarkable, that although there were between twenty and thirty children in our workhoufe, only one had the difeafe." In the treatment the author thinks that calomel, in alterative dofes, as recommended by Dr. Rufli, proved a ufeful remedy. pened on the evening of the third, or morning of the fourth day. The eruptions-were firft vifible on\the face ; and began to fade every where on the flxth or feventh day, but feldom difappeared entirely fooner than the tenth-They were rather more prominent than thofe which I had obferved in Europe, and the branny ikurf left on the fkin was confiderably lefs: in other refpe&s there was no material variation from Sydenham's Accurate Defcription of the Meafles, epidemic at London in the Year 1670. " After the-beginning of March, the difeafe became more for^ ? midable. The eyes were more inflamed, the coryza, the cough, and the febrile fymptoms were in a greater degree than in the former months. The eruption appeared irregularly from the fecond to the feventh day of the fever. The eruptions often appeared on the breaft before they were feen on the face; they were of a fainter colour, and the branny lkurf was, in general, lefs. A vomiting and diarrhoea were common fymptoms from the beginning; the latter continued throughout the difeafe; the former ufually Ceafed as foon as the eruption was complete: but very young fubje&s continued ^to be harrafled by retchings, excited by the irritation of fneezing or coughing. ? About the height of the difeafe, phe fick were fubjett. to fliort exacerbations of the fever, accompanied with difficulty of breathing, and flitches in the cheft, which recurred. f<?veral times in the twenty-four hours. On the whole, the Meafles, after the month of February, approached nearer to the anomalous fpecies defcribed by Sydenham under the year 1674. " From the end of February, the Small-pox, which hitherto had been of a mild diftindt kind, became irregular and much more fatal. The puftules were confluent on the face; on other parts diftinft, but generally flattifh, and indented at the top. In many cafes they fuppurated imperfettly ; in others, they remained dry or hulky : and fome inftances occurred of their turning black about the feventh day. A diarrhoea and tenefmus frequently attended from the beginning to the end. " Though a large proportion of the infe&ed ftill recovered, they continued long in a flckly Hate. Children were not only reduced by the diarrhoea, but were often attacked with the hoopingcough, or with erratic fevers, both being at that time epidemic in the city. In the more malignant kind of Small-pox, many died between the feventh and ninth day; fome ftruggled to the eleventh ; very few recovered. " When the Small-pox and the Meafles prevailed in the fame feafon, many of the children fuftered both difeafes in fucceflion, as ufual. The Meafles were rarely obferved to fucceed the Smallpox in lefs than twenty days, reckoning from the eruption. The Small-pox commonly fucceeded the Meafles fomewhat earlier in the third week ; but feveral cafes were met with, in which the puftules of the Small-pox were'difcovered on the face, before the total difappearance of the Meafles on the limbs; that is, on the eleventh or twelfth day.

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?*? It has already been remarked, that, few of the jnfe&ed in either difeafe died before the month of March. But from that time the mortality in the Small-Pox was coniiderable; as thofe who had juft before fuffered from the Meafles, atxl were redviced by the diarrhoea to a ftate unfavourable for-the reception of a fatiguing diftempei^ generally perilhed; unlefs the fupervening Smallpox was of a mild kind. The danger appeared to be rather lefs where a bad kind of Meafles fucceeded the Small-pox.
'< The reciprocal influence of the two difeafes in the fame fubjedb was carefully attended to in above three hundred eafes; and fo little did the quality of the firft difeafe feem to influence that of the fecond, that a mild, diftinft Small-pox was often obferved to follow the worft kind of Meafles, and vice verfa.
JUr. y&tner's Address on Vaccine Inoculation. eomparifon, the peculiar differences which mark the Small-pox and Cow-pox;" and he affirms that the ftatement is " in every particular, confirmed by very extenfive experience." After the comparifon of the advantages which are to be derived from the fubftitution of the Vaccine Difeafe for the Small-pox, the author obferves, " It is perfeftly confiftent with my prefent defign, briefly to notice the moft popular objections which have been urged againft the introdu&ion of Cow-pox. " It has been called a beftial humour, and by a fallacious aflbciation of ideas, it is fuppofed to introduce an unnatural diieafe into the eonftitution. " If this very weak and futile objection were worthy of reply, we might obferve, that the cow is of all others the moft healthy and the moft cleanly of our domeftic animals, and might alfo remark, that no females ire fo healthy as our dairy maids, whofe morning and evening hours are fpent amongft the cows; and we Ihould not forget that eminent phyficians recommend invalids to avail themfelves of the falubrious effedts of the breath of the heifer. How void of foundation then mull be the obje&ion to the infertion of an atom of matter taken from the teat of the cow, once in the life only, when every perfon is in the daily habit of introducing into ?his ftomach various parts of the fame animal. The human ijomach revolts not at beef, butter, cheefe, and cream; yet every one, acr quainted with the animal economy, muft know, that thefe aliments are quickly mingled with the eonftitution. " Another grand objedlion (which indeed is the only one that Jlrikes at the foundation of our theory) is, that perfons are liable to be affeSed with fmall-pox after having been inoculated with the Cow-pox. v.' ; ? " A very extenfive pra&ice, and an equally extenfive communi? cation of the experience of medical friends of the firft reputation, 'would almoft warrant a ftiort, abrupt anfwer to this queftion; an anfwer conveyed in terms unaccommodated to the feelings of the prefent age. After this objedlion, which has been refuted as often as it has been urged, a laconic reply, conveyed in no polite language, would by no means be improper, as it would harmonize with the general mode of fuch objections; and by all laws, the anfwer ought to be of the colour of the queftion; but wbat .is not owing to cavilling individuals, is a juft debt due to a candid and judicious public. " Every cafe that has been brought forward to undermine the theory we. defend, we can prove to a demonftration was not one of the genuine kind. There are three difeafes which have indifcriminately been termed Cow-pox, only one of which is the real prevent tive of fmall-pox. In the fpring feafon particularly, cows are fre? quently fent to market for fale: the farmer omits to milk them in the morning, previous to their fetting out, that their udders may appear full, and the animals on that account become more valuable. The frequent ?onfequence is, that inflammation enfues, which terminates in eruptions on the teats and adder, and affe?U the 15 the milker with a loathfome difeafe on the hands, arms, and flioulders.
The forehead fometimes does not efcape, from the circumftance of the ferVant's leaningagainft the uddijr in milking. This difeafe may affedt the fame perfon feveral times, but it will never prove.a preventive for Small-pox: a cafe of this kind occurs in the city of Briftol; a Mr. Jacobs, attorney at law, was extenfively affedted tivice with this difeafe (which, from his total ignorance of real Cow-pox, he has called by that name,) but it did not prevent his being aiflitted with a fubfequent fevere Small-pox. It is almolt univerfally allowed that the anatomical terms which are at prefent in general ufe, are very imperfett, and by no means correfpond with the numerous and ufeful difcoveries in this fcience; an attempt to correal thefe defedts will not now be confidered fo daring an innovation as it might have been formerly. Mons. Dumas, as profeflor of anatomy, was conftantly remarking the difficulty of teaching this fcience from the crowd of abfurd names given to various parts ; and has undertaken in this work, the very arduous and ufeful talk of re&ifying them; and though he may not have fully anfwered our expe&ations, yet we think a tranflation of this work, with forae alterations that would occur on a careful perufal, would be a very acceptable prefent to the ftudents of anatomy of this country.^ In the third chapter, the author confiders fome of the defetts of anatomical language in general, and the mode of correcting itj and we tranflate the following as a fpecimen of his manner of treating the fubjeft. " A flight examination of the moft common anatomical terms will be fufhcient to Ihew the incorre&nefs and impropriety of a great number of them. There are fome which are ftri&ly arbitrary, and others which have no determined fignification, and which any anatomift may change at pleafure. Under this clafs may be ranged all thofe denominations drawn from numerical orders, &c. which exprefs neither fituation, form, figure, nor connexion, but only the number of parts, which does not define any rhing anato?nically.
Of courfe, we rejeft the names of firft, fecond, and third phalanx, &c. terms given to bones which have no agreement or relative fize. Vefalms' s terms of firft, fecond, third, fourth, fifth, fixth, &c. Prof. Dumas, on the Muscles of the Human Body. + I and firft and fecond external radial; and fimilar names given to mufcles which differ in fituation, attachment, and figure, muft at once appear ridiculous. " If anatomical terms Tiave fometimes a vague and arbitrary fignification, there are feveralsthat have no meaning at all. What fenfe can be annexed to blind hole, ojfa innominata, accejfary mufcle, fubli'me mufcle, humble mufcle, profound mufcle, pudendal artery, &c. &c. Turks faddle, far <vagu?n, recurrent nerve, nates, tejles iff vulva cerebri? How is it poifible to affociate fuch ridiculous expreffions with any true and clear ideas of anatomy? V There are other names perhaps lefs abfurd, although not more regular, which actually tell us what they do not mean?fuch are the names of vena ca<va^ which is not the only vein that is hollow, and duttus arteriofus to diftinguifh a duft, which is a&ually ligamentous in the adult.?Arber vitee, to characterize the ramifications which the internal furface of the cerebellum prefents when cut vertically, and in which nature has not exclufively placed the feat of life, &c.
" The frequent ufe of terms in an abfolute fenfe, which are only relative, is an effential defeft in anatomical language. The adjeftives, great, little, vajl, thin, fuperior, inferior, Jhort, long, right, left, are examples of this impropriety. When we talk of the great and little wings of the fphenoid bone, the great and little condyles of the humerus, the great and little trochanters of the thigh, the great and little angle of the eye, and the great and little bones of the tarfus, it is impoflible to comprehend them. The epithets of great bone, grand artery, great and little faphena, great and little fympathetic, great and little meferaic, can never be confonant to a proper nomenclature, and ought to be abolifhed, fince great, little, long, Ihort, &c. are not effential properties, but only qualities relative to a part, and can only ferve in the defcription of one part." , It would occupy more room than we can poffibly allow in our Journal to follow the author in his cenfures on all the abfurd names that are in general ufe, as well as the idle vanity of denominating parts after the difcoverers of them; who, the author juftly observes, have no occafion for fuch auxiliaries to render their names immortal; not to mention the poffibility of attributing a difcovery to one perfon, when it adtually belongs to another.
The author's plan is to divide the human body into forty-feven different regions, all of which have particular names, and under which all the mufcles may be ranged in a natural order, and immediately found as indicated by their proper heads and clafles j and he thinks this method will facilitate both the ftudy and inveftigation of anatomy, by aifembling together what ought to be united, and feparating what ought to be divided, as putting each mufcle in its proper place, and circumfcribing its limits; and, although he ? fays the fame idea has been adopted by Chaujjier, he thinks his own an improvement upon it.

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To illuftrate his mode, the author has given us tables of the tnufcles. arranged under diftinft columns according to their regions, with their old and new names, fituation, firft attachments, fixed points, direction, laft attachments, points of infcrtion, compofition and figure, connexion, and ufes. And at the end of the work he has added an ufeful di&ionary of fynonyms of all the mufcles of the human body from the beft authors. periodical publication propofe to collect all contributions relating to natural and medical lcience, by which both are, as well in general as in their fingle parts, illustrated, enlarged, and corrected, and the practical application of them, for the prefervation of health, and cure of difeafes, really improved; but merely, as far as this is owing to the induftry and genius of northern (Swed.fh and Danifh, Sec.) phyficians, furgeons, and naturalills. W e lhall be enabled, by this ufeful publication, to get acquainted with the ftate and progrefs of medicine in the North, of which we have had hitherto but little knowledge; and the well known talents of the Editors, and the interefting contents of the firft number, give us reafon to hope, that this undertaking will anfwer their views, and fatisfy the expectations of the learned. We find here, amongft the Original Papers, l. Ne-zv Experiments an Refpiration and its ufe, by Prof. Abilgaard, With Remarks of Prof. Pfaff.?Thefe experiments are dire&ly oppofite to the generally adopted dodtrine of refpiration, and Mr. Abilgaard attempts nothing lefs than to prove by them, that very little air, or none at all, enters into the lungs during infpiration ; againft which Prof. PfaiF defends in his remarks the general opinion. 2. Diffusion 0/' a drowned horfe, by J. Kuhn, with fome phyfiological remarks of Mr. Herholdt and Rafn.?The objed of this paper is chiefly concerning the air bladders that are found in large drowned animals. 3. Experiments on Gal<vanifm, are contributions to Mr. Humboldt's work on the fame fubjedt. 4. Contributions to the hijlory of lar<vated and contagious intermittent fevers, contain fome interefting observations. 5. On Small-pox Inoculation, by Prof. Pfaff, where he relates fome obfervations made in inoculating a great number of children in Several villages at once. 6. Defcription of a hooked forceps, and a perforator, with a Jheath, by Dr langen, Walther. We cannot bat approve the excellent plan which the author has adopted here, in"*propofing the elements of chemiftry; and we are fully convinced that it is perfe&ly calculated to fatisfy the requifites which the vaft progrefs of that fcience entitles us to expedt from a Philofophical Syftem of Chemiftry. Mr. Hildebrandt intends to include the whole chemiftry in a fyftematical, and, as far as poffible, in a mathematical order; with fuch a combination of theory and pra&ice, that it may prove a very ufeful manual, not only for the philosophic and profeflional chemift, but alfo for a common reader, and for the ufe of life. With refpeft to this, the prefent Work is to comprehend as well all parts of applicated as of pure chemiftry, to the former of which a proper fettionis to be devoted. The theoretical part is to precede, to which the practical will follow, in fuch a manner that its rules may be derived from the theory, and the refults in the different operations explained by it. The whole is written with as much concifenefs as poffible, and the paragraphs are therefore but aphoriftic, and the quotations but few.
How far, however, the author has fulfilled this difficult and intricate tafk, which he has planned to execute, we lhall not be able to' judge till more numbers have made their appearance. In the prefent number we find, according to the plan, the theory of the different elements in general, of heat, light, oxygen, azote, atjnofpheric air, of hydrogen, and of water.
J. Van  The Author of this learned Diflertation treats, firft, of themorbific oflification which takes place in the preternatural fwelling of the bones themfelves, and afterwards of the oflification in the cartilage, in the membranes,v and other foft parts of the body. From his inquiries and ftridl obfervations of the procefs which Nature follows in forming fuch bony fubftances, it appears, Naturam in ofteogenefi prasternaturali, habita jpartium, quibus contingit ratione lion minus ac in aliis aberrationibus constantes fequi leges atque overturn in agendi modo ordinem femper fervare.
In the accurate explanation of thefe laws the Author (hows with much acutenefs, how conftant they really are, notwithftanding the appearance of irregularity with which the morbid accumulation of bony matter feems to iffue ; and it appears that Nature afts here, like\vife, according to eftablifhed organic regulations; and thus, what has been otherwife called a concrementum inorganicum, /ought properly to be confideired as a regular produftion of Nature. The Author then proceeds to difcufs, copioufly, upon the exuberance of callus; and having examined the late opinions of the noncxiftence of callus, he gives his own opinion, which he illuftrates by Dr, Hecker's and Dr. Brandts's Theories on Dentition. 77 by a very good figure of a morbific bone. His definition of the callus luxurians is the following : " Callus luxurians vocatur, qui majoca copia formatus eft, quam ad deperditam non folum offis fubftantiam reftaurandum fed etiam ad debitam fanitati convenientem firmitatem toti offi tribuendam requirebatur." In accurately furveying a bone, where luxuriant callus has been formed, it is apparent that plaftic Nature never performing any thing fuperfiuous, does not produce an exuberance and deformity of callus from mere luxuriance, but that.it is always occafioned by certain external and internal caufes, by which the formative aft of Nature is difturbed and rendered irregular; how they aft and influence upon the formation of the callus is amply explained by the Author.
Critical Survey of the Lateft Theories on difficult Dentition in Children.
(Partly extradled from the Journal of Invention, Theories, &c. in German. Numb. XXXI. i?o6.) Dentition has been always confidered as a matter of great importance in difeafes of children, and all the different and fometimes dangerous affeftions incident to the infantile age at the time they are cutting their teeth, have hitherto been fuppofed by almoft every praftitioner to originate from the irritation of the gums by teeth breaking through; and the appellation of dentitio diff.cilis comprehends a feries of fymptoms, that, however they may differ in their external appearance, are derived from the fame fource. A fwelling and inflammation of the gums, with a great falivation and violent pain, and even fpontaneous hydrophobia, a collection of pituitous matter in the breaft, a laborious breathing, coughs, or continual vomition of bilious matter, vehement diarrhoeas, convulfions, and other fpafmodic affeftions; fevers with acute exanthemata, a fuppreflion, or a fuperabundant excretion of urine, or a preternatural fharpnefs of it; an inflammation of\the urethra and prepuce, with a kind of gonorrhoea; all thefe are mentioned bymedical writers as immediate fymptoms of teething, however increafed and changed by other concomitant caufes, as colds, fmall pox, worms, &c.
Such was the prevailing opinion of dentition, and the fymptoms that fometimes attend it, till of late it has been made a matter of inquiry and difcuflion. Three of the moft refpeftable authors and phylicians of Germany, finding great difficulties in explaining thofe fymptoms according to the opinion which was generally adopted, made an attempt to eftablifh new theories on dentition, by which alfo the praftice in thofe affeftions is greatly influenced. Although they agree, that the mere irritation of the gingiva cannot be allowed to be the immediate caufe of thofe fymptoms, yet they differ very much in the explanation and theory they refpeftively give of their nature and origin. It is certainly undeniable that the idea of difficult dentition has been too far extended ; but whether, on the other fide, it ought to be confidered of no immediate influence at all, is ftill a matter of difpute, as will appear from the obfervations annexed. It is proper 7 78 Dr. Hecker^s and Dr. Brandish Theories on Dentition.
now, however, to proceed to give a concife account of each theory ;* of which we ftiall firil relate, ' 1 I. Dr. Heeker's Theory, (contained in his Magazine for Pathological Anatomy and Phyfiology. Nuinb. I.) The common opinion of the ad of teething in children is fubjed to fome difficulties, as it cannot be well explained, how it is poffible a part, as the gums, not poffelled of much fenfibility and irritability, only by being irritated from the teeth cutting through, fliould produce fuch violent fymptoms, as are obferved fometimes during the period of firft dentition. Another caufe ought, therefore, to be fought for, that will prove more fatisfadory in explaining, and more ufeful in direding a proper pradice and cure of thofe fymptoms, to which fo many children fall a facrifrce.
It is a general law founded upon fads and experience, that as foon as the organs of fecretion are difeafed or affeded in a morbid manner, they fecern fuch humours as are alfo morbid and preternatural. Thus, an irritation of the liver will produce a fharp and corrupted gall; paffions often render the milk venomous; and the mildeft faliva of an irritated and angry animal becomes very malignant and poifonous. Now, in a child that is cutting teeth, many circumftances take place, which are fufficient to turn the faliva into a very powerful, malignant, and even deadly poifon. We obterve a great colledion of faliva and an irritation in the mouth of a teething child ; it fuffers a great deal of pain; reftlefs and fleeplefs, 'it is continually crying, irritated, and in a degree of paflion. This, already, may lead us to conjedure, that the faliva acquires fuch a malignity as to be able to caufe many and very dangerous fymptoms of difficult dentition. It will, however, .be ftill further proved by the following arguments : That a corruption and acrimony of the faliva, almoji Jimilar to that in the canine madnefs, is the principal caufe from 'which all the tnojt dangerous fymptoms of dentition are to be derived.
1. Many fymptoms of dentition admit of a more natural and eafier explanation from this faliva than from the irritation only, viz. the coughs, laborious breathing, the colledion of pituitous matter in the breaft, fuffocation, &c.; fwallowing it caufes vomition and diarrhoea. When it poffefles a high degree of acrimony, or when its excretion is by any means obftruded, it produces infenfible and irritable conflitutiOns, hydrophobia, locked jaw, epileptic fits, &c. The acrimony being imparted to the humours, gives rife to fevers and exanthemata. The inflammatory and gb? norrhoic affedions of the genitals are owing to acrid faliva having thrown itfelf upon the urinary fyftem; a complication of dyfentery and dentition is confequently very dangerous, becaufe the bowels are thus likely to be doubly affeded.
2. Dentition has been obferved to be flight and eafy whenever the falivation was conliderable, or falival humours evacuated byother emundories of the body.
3. There is a great fimilarity between the fymptoms of difficult dentition Dr. Hecker's and Dr. Brandish Theories on Dentition. dentition and thofe of real hydrophobia, apparent from the impediment in fwallowing, and other fpafmodic affedtions.^ 4. Several children, who died of difficult dentition, had bloody ftools, attended with a tenefmus, as in dyfentery. Upon diffe&ing the body, erofions and inflammations were found in the throat, ftomach, and intellines, which were moft probably caufed by the acrid faliva ; fomething fimilar has been noticed in the ftomach of perfons who have died of hydrophobia. > 5. The cure confifts in diminilhing* the irritation in the mouth, in removing the inflammation of the gums, of the falival glands, and the tohfils. To evacuate the fharp faliva, and to render it lefs noxious, are indications to which we are led by Nature itfelf. The moft difficult dentition becomes lefs dangerous when there is muck, falivation, vomition, and moderate diarrhoea.
The principal remedy is the fixed cauflic alkali, or the 'volatile alkali, which has been already recommended by Fred. Hoffmann. When this is given early enough, before the nervous fyftem is too Jttiuch affedted, or before too vehement fpafmodic or even apopletic fymptoms have arifen, it certainly is able to fave the life of many children. . It moreover, in general, is a very ufeful remedy, whenever the organs for the fecretion of lymphatic humours being irritated and inflamed, fecern morbific fluidities; for inftance, in gonorrhoea, in fome cafes of dyfentery, catarrhous inflammations of the throat and breaft, hydrophobia, &c. Blifters applied behind the ears are of great fervice. The incifion of the gums can only ferve to mitigate the violent inflammation, but does by no means promote the cutting of the teeth. Opium ihould be avoided, or ufed at'leaft with great caution, as apopledtical fits, of which many children die in dentition, are frequently brought on by it. Extrattum hyosciami may be given inftead of if; nvarm baths have likewife great effedt in removing the fpafms and pains, and in promoting falutary excretions. Emetics and cathartics are alfo fometimes very ufeful.
II. Dr. Brandis*s Theory. The intelligent Dr. Brandis, of Brunfwick, known by feveral excellent publications, and Tr^nuator of Darwin's Zoonomia, advances his opinion about the nature and origin of the dangerous fymptoms fometimes obfervable at the time of firft dfentition, in his book on Metajlases, 1798^ in German. Although he agrees with Armftrong and Hecker, that they are not to be derived only from the irritation of the nerves of the teeth, yet he rejedts their theories, and rather thinks, that a suppression of salival secretion has the principal (hare in producing thofe fymptoms. The fecretion of fa-* liva is much incrcafed by the topical irritation in the mouth, and becomes very neceffary to the conftitution of the child. When the topical irritation is too vehement, in a difficult dentition, it extends to the falival glands, and caufes a fuppreffion of the fecretion of faliva. It may be obferved, therefore, that the mouth and lips become dry and cold, in bad cafes j meanwhile, there is a great degree 8o jDr. Hedges and Dr. Brandish Theories on Dentition, degree of febrile heat in other parts of the body, which is a diagnoftic fign ?f this dangerous difeafe. When the fuppreffed aftion of the falival glands is replaced by that of the pancreas, a diarrhoea comes on, which, as it generally continues as long as the difficult dentition is accompanied by thofe fymptoms, contributes very much to diminilh the violence of them, and of the concomitant fever. But, on the contrary, when this does not take place, nervous fymptoms, convulfions, and a nervous fever arife, which having a great fimilarity with Hydrocephalus Internus, is very wel} defcribed .by Armftrong under the name of hettic fever.
That thefe nervous fymptems cannot be afcribed to the nervous irritation arifing from the teeth cutting through, may be farther proved by the following confiderations : 1. Nervous fymptoms, arifing from a re-aftion of the fenforium caufed by the pain, are never removed by any material excretion, as this manifeftly happens in difficult dentition 'by faliv&tion and & diarrhrea of watery humours. * 2. All anodynes and antifpafmodic remedies, opiates particularly, which in convulfions proceeding from pain, prove fo very efficacious, are without any avail here, of which circumftance Dr. Bv. had frequent experience. -3. The incifion of the gums ought to remove the caufes of the difeafe at once, according to the theory generally believed ; but in forfr cafes, where he faw it ufed, it was not only of no immediate utility, but in fome inftances, by additional irritation, it increafed the nervous fymptoms. A healthy child, fifteen months old, having fuffered a flight degree of cold, was fuddenly feized with all the fymptoms of difficult dentition. Emetics, mercurial purgatives, fomentations of the mouth, &c. were applied in vain. It lay fenfelefs, with its mouth open, and cold; the pulfe was hardly perceptible, and vehement convulfions came on from time to time.
The gums were cut in on both fides to the teeth themfelves, after which it feemingly recovered a little ; but foon after, the mouth and the lips remaining dry, pale, and the cheeks cold, the fever and convulfions returned ; and though the operation was repeated, aod ointments rubbed in, outfide and infide, it died the next dayi The gums were found divided by the operation, and the teeth free and vifible, but no inflammation could be traced on the margin of the incifed gums. The operation ftiould have certainly faved the child, if the difeafe had been dependent from the cutting of the teeth, and a falivation would have had that effect.
In examining thofe theories, the arguments fhould firft be confidered, by which they have attempted to prove that the fymptoms derived from difficult dentition are not owing to the irritation of the gums, on account of their being lefs fenfible, and not provided with nerves, as to be able to caufe thofe fymptoms ; that the incifion of the gums is of no utility, and, confequently, that the nature of the fymptoms themfelves is by no means correspondent with the quality of the caufe they are fuppofed to be occafioned by. Although the theories juft propofed are partly grounded upon thofe confiderations, br. Hecker's and Dr. Brandts's Theories en Dentition, Conliderations, yet it may be proper to defer reviewing them till we relate Dr. Wichmann's Theory, as it is particularly urged by that gentleman. ? ; , Both Theories are certainly very ingenious and plaufible, feveral doubts, however, maybe raifed againft^ them, to which they feeni to be expofed. In the firft place, Dr. Brandis objedls to Dr. flecker's opinion, that, as the fymptoms of difficult dentition do not arife before the falivation is entirely fupprefTed, and confequently before the fecretion of any faliva is flopped, they cannot owe their origin to its acrimony, of which quality he never could perbeive any figns in a teething child. But fhould not the exiftence and action of fuch an acrid humour be proved ty the erofions and inflammations that have been found in the throat, ftomach, and inteftines of children dying in a high degree of difficult dentition ? However, even when this is allowed, it n}ay be fuggefted, that it would be more proper, and agree better with cur improved knowledge of animal ceconomy, to derive primarily the morbific fecretion of the faliva, and the fymptOms of difficult dentition, from the fame proximate caufe which confifts in the nervous irritation, and to confider both as the congenial effeft of it, and not the morbific faliva as the original caufe of thofe fymptoms. It is moreover obvious to remark, in general, that the idea of an acrimony wandering through the body, and caufing, difeafes, is by no means evident, but built upon hypothetical principles.
The opinion of Dr. Brandis is founded upon Jus theory of metaftafes, which he has propofed in the work above mentioned. According to this, the idea of a metaftafis ought to be thus conceived: " When certain attions in any organ, or fyftem of organs, ceafe, or are by any means diminilhed, they muft be replaced by another adion in another organ or fyftem of organs of the body, dependent from the former aftion. The firft may be called the original; the fecond, the 'vicegerent aft ion" In dentition, now, the lecretion of faliva is the original aftion of the falival fyftem; tauled by the topical irritation in the mouth, which in a teething child is become nefceffary to its conftitutiori. If that a&idn happens to be Hopped, a vicegerent attidn is excited in another organ ; and if this takes plafce in thfc nervoiis fyftem, all thofe dangerous fyihptoms appear which are to be attributed to difficult den-* tition. It is, howiever, not reqiiifite, and would lead us too fdr> to enter into the particulars of this ingeriious theory ; it may filffice to obferVc, that the fuppreffiOn of falival fecretioh mighU be jnore naturally confidered as the effett of nervous irritation, which by its violence, at the fame time produces the other fymptdfns of difficult dentition. This explanation is fuitable to a knowri law of the aninial ccconomy, atcording to which, fecretions are increafed by a moderate degree of irritation, and fupprefTed Whenever it becomes tod vehement. When falivation, therefore, is not fuppreffed, but rather inc-feafed, and the fymptoms without danger, the irritation of the nervous fyftem is moderate, which beipg relatively vehement, muft be looked apon a$ the common caufe of both, Numb. XYIL M, Vhe